Blunt Abdominal Trauma

Posted by e-Medical PPT
Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. Identification of serious intra-abdominal pathology is often challenging. Many injuries may not manifest during the initial assessment and treatment period. Mechanisms of injury often result in other associated injuries that may divert the physician's attention from potentially life-threatening intra-abdominal pathology.
Injury to intra-abdominal structures can be classified into 2 primary mechanisms of injury–compression forces and deceleration forces.
Compression or concussive forces may result from direct blows or external compression against a fixed object (eg, lap belt, spinal column). Most commonly, these crushing forces cause tears and subcapsular hematomas to the solid viscera. These forces also may deform hollow organs and transiently increase intraluminal pressure, resulting in rupture. This transient pressure increase is a common mechanism of blunt trauma to the small bowel.
Deceleration forces cause stretching and linear shearing between relatively fixed and free objects. These longitudinal shearing forces tend to rupture supporting structures at the junction between free and fixed segments. Classic deceleration injuries include hepatic tear along the ligamentum teres and intimal injuries to the renal arteries. As bowel loops travel from their mesenteric attachments, thrombosis and mesenteric tears, with resultant splanchnic vessel injuries, can result.
The liver and spleen seem to be the most frequently injured organs, although reports vary. Small and large intestines are the next most injured organs, respectively. Recent studies show an increased number of hepatic injuries, perhaps reflecting increased use of CT scanning and concomitant identification of more injuries.
Bedside ultrasonography in the form of focused abdominal sonogram for trauma (FAST) has been used in the evaluation of trauma patients in Europe for more than 10 years and is increasingly gaining acceptance in the United States. FAST's diagnostic accuracy generally is equal to that of diagnostic peritoneal lavage (DPL). Studies in the United States over the last few years have demonstrated the value of bedside sonography as a noninvasive approach for rapid evaluation of hemoperitoneum. The studies demonstrate a degree of operator dependence; however, some studies have shown that with a structured learning session, even novice operators can identify free intra-abdominal fluid, especially if greater than 500 mL of fluid is present.

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